| NPI | 1376813014 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON TAWN HARRIS Facility Manager 765-412-0788 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05009075A) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: IN 31004248A) |
| 235Z00000X Speech-Language Pathologist, (Licence: IN 22004133A) | |
| Enumeration Date | 2012-01-11 |
| Last Update Date | 2012-01-11 |